Pancho - GAM-JUA-05

Code: GAM-JUA-05
Mercy ID: V-02124-21
Encounter Date: 02/08/2006
Last: Gama
First: Juan
DOB: 12/09/2005
County: Dekalb
Street: 3504 Chamblee Dunwoody Way
City: Chamblee
State: GA

Zip

30341-

Home

(770) 458-6268

Family Status

Attached youth

COB

USA

Gender

Male Child

Housing

Not Homeless

Education Level

Child, not in school

Home Owner

No

Parents Information

	Name	DOB	COB
Mother	Martha Vergara	08/25/1981	Mexico
Father	Esteban Gama	12/05/1973	Mexico
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: Parents
Name of School: N/A
Grade: N/A
Who Can't Pickup the Child
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: R. Gonzalez
Data Entry: R. Gonzalez